VASCULAR ACCESS FOR HEMODIALYSIS: OUR EXPERIENCE WITH 3337 CASES

Over a seven year period from 1982 to 1989,3337 conduits were created in 3137 patients with end stage renal disease (ESRD) as access for chronic dialysis. These included 2690 side-to-side arteriovenous fistulae (A VF), 168 end-to-side A VFs, 10 autogenous vein grafts, 51 homogenous frozen vein grafts, 109 polytetrafluoroethylene (PTFE) grafts, 209 emergency external arteriovenous shunts, three dual-lumen catheter placements with dacron felt cuff in the superior vena cava and 13 miscellaneous vascular access procedures. Our favorite site for creation of A VFs along with satisfactory patency rates for as long as seven years are demonstrated for all types of fistulae and PTFE grafts by life-table analysis. Early failure of A VFs usually occurred in the postoperative period due to hypotension, and late failures were due to improper use of the vein during dialysis. Thrombosis was the cause of the majority of the PTFE graft failures, even though we had four cases of infection more than one year later and one case of seroma formation due to weeping of the graft. False aneurysm formation and secondary bleeding requiring repair were the major complications of PTFE grafts. Autogenous or frozen banked homogenous vein graft failures were mainly due to gradual fibrosis and narrowing and eventual thrombosis, while we did not have infection or false aneurysm formation or any other complication with them.